When you’re planning a pregnancy and live with epilepsy, the choices aren’t simple. You need to control seizures to protect yourself and your baby-but some of the most effective medications come with serious risks. It’s not about avoiding medicine altogether. It’s about choosing the right one, at the right dose, with the right support.
Some Seizure Medications Carry High Risks During Pregnancy
Not all antiseizure medications (ASMs) are the same when it comes to pregnancy. Some have been linked to a much higher chance of birth defects. The most concerning is sodium valproate. Studies show that around 10% of babies exposed to valproate before birth develop major physical birth defects-like heart problems, cleft lip or palate, or spinal issues. That’s more than double the risk seen with most other seizure drugs.
Valproate doesn’t just affect physical development. Children exposed to it in the womb are nearly twice as likely to be diagnosed with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), according to research from Indiana University published in Neurology in 2020. These aren’t rare outcomes-they’re predictable patterns tied directly to the drug.
Other high-risk medications include carbamazepine, phenobarbital, phenytoin, and topiramate. The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) confirms these four carry increased risks of physical malformations. The risk rises with higher doses. For example, taking more than 800mg of carbamazepine daily during pregnancy raises the chance of birth defects significantly.
But here’s what many don’t realize: even with these risks, more than 90% of babies born to women with epilepsy are healthy. That’s because medicine has improved. The rate of major congenital malformations dropped by 39% between 1997 and 2011-not because fewer women got pregnant, but because doctors started prescribing safer options.
The Safer Alternatives: Lamotrigine and Levetiracetam
If you’re planning a pregnancy, the goal isn’t to stop all medication-it’s to switch to the safest effective option. Two drugs stand out: lamotrigine (Lamictal) and levetiracetam (Keppra).
Research from Stanford Medicine, published in JAMA Neurology in 2021, followed 298 children whose mothers took these newer drugs during pregnancy. At age two, their verbal skills were on par with children of mothers without epilepsy. No major increase in birth defects. No clear link to autism or ADHD. These aren’t perfect-but they’re the best options we have right now.
The MHRA review in 2023 specifically named lamotrigine and levetiracetam as safer choices. They’re now the first-line recommendations for women of childbearing age who need seizure control. That doesn’t mean they work for everyone. Some people need stronger drugs to stop seizures. But if you can switch safely, you should.
Drug Interactions Can Be Just as Dangerous
It’s not just about what you take-it’s about what you take with it. Many antiseizure drugs interfere with hormonal birth control. Carbamazepine, phenytoin, phenobarbital, high-dose topiramate, and oxcarbazepine can make the pill, patch, or ring much less effective. That means unplanned pregnancy-and if you’re still on a high-risk ASM like valproate, that’s a dangerous combination.
The flip side is just as tricky. Hormonal contraceptives can lower the blood levels of certain ASMs. Lamotrigine, valproate, zonisamide, and rufinamide all become less effective when taken with birth control pills. That raises your seizure risk. A 2023 study from AESNET found that 66.7% of women of childbearing age with epilepsy answered basic questions about these interactions incorrectly. That’s not a knowledge gap-it’s a public health failure.
So what do you do? If you’re on lamotrigine and using hormonal birth control, your doctor may need to raise your dose. If you’re on carbamazepine, you shouldn’t rely on the pill alone. Use condoms. Consider an IUD. Talk to your neurologist and gynecologist together. These interactions aren’t theoretical-they’ve led to unplanned pregnancies and unsafe drug exposures.
Uncontrolled Seizures Are a Bigger Threat
It’s easy to focus on the risks of medication and forget the danger of seizures. A tonic-clonic seizure during pregnancy can cause miscarriage, premature birth, or oxygen deprivation to the fetus. The mother can fall, hit her head, or stop breathing. In some cases, the seizure itself is more dangerous than the drug.
Kelsey Wiggs, the researcher who studied autism risk with valproate, calls this an “excruciating double bind.” You need the medicine to stop seizures. But the medicine might harm your baby. There’s no easy answer-only the best possible choice.
The American Epilepsy Society says it clearly: no ASM is as dangerous to a pregnant person or their baby as uncontrolled seizures. That’s why stopping your meds without medical advice is never safe. The NIH warns against this too. If you’re thinking of going off your medication because you’re worried about birth defects, talk to your doctor first. There’s almost always a better way.
Preconception Planning Is Non-Negotiable
You don’t wait until you’re pregnant to figure out your seizure plan. If you’re a woman of childbearing age and take antiseizure drugs, you should already be talking to your neurologist about pregnancy. This isn’t optional. It’s standard care.
Preconception counseling means:
- Reviewing your current medication and switching to a safer option if possible
- Adjusting your dose to the lowest effective level
- Checking your drug interactions with birth control
- Starting folic acid (at least 5mg daily) before conception-this reduces neural tube defect risk
- Planning for close monitoring during pregnancy
Studies show that women who get this kind of planning have far better outcomes. Their babies are less likely to have birth defects. Their seizures are better controlled. Their stress levels are lower.
But here’s the hard truth: not everyone gets this care. A French study found that women with lower income or fewer resources were more likely to be prescribed high-risk drugs like valproate during pregnancy. That’s not because those drugs are better-it’s because access to specialist care is unequal.
What About the Newer Drugs? Are They Safe?
There are 11 other antiseizure medications that still lack enough data to confirm their safety in pregnancy. That includes drugs like cenobamate, perampanel, and ezogabine. Researchers are still watching them closely.
But the trend is clear: newer drugs are safer. The 39% drop in birth defects over 14 years didn’t happen by accident. It happened because doctors stopped prescribing valproate to young women unless absolutely necessary. They started using lamotrigine and levetiracetam first. They started testing blood levels more often. They started talking to patients before pregnancy, not after.
Stanford neurologist Kimford Meador says women today should feel “better about their opportunities and options for having a child.” That’s not marketing-it’s science. The tools are better. The knowledge is better. The care is better.
What You Can Do Right Now
If you’re taking antiseizure medication and could get pregnant:
- Don’t stop your meds without talking to your doctor.
- Ask if you’re on a high-risk drug like valproate, phenytoin, or carbamazepine.
- If you are, ask if switching to lamotrigine or levetiracetam is possible.
- If you’re on hormonal birth control, ask if your ASM reduces its effectiveness.
- Start taking 5mg of folic acid daily-even if you’re not trying to get pregnant.
- Request a preconception counseling appointment with your neurologist.
If you’re not taking medication but have epilepsy, and you’re thinking about pregnancy: talk to your doctor now. Don’t wait. The sooner you plan, the safer your pregnancy will be.
It’s Not About Fear. It’s About Control.
Seizure medications and pregnancy don’t have to be a nightmare. They can be managed. They can be safe. But only if you act with information, not fear.
The data is clear: valproate is dangerous in pregnancy. Lamotrigine and levetiracetam are much safer. Drug interactions can ruin your birth control. Uncontrolled seizures can kill your baby. But with the right care, you can have a healthy pregnancy and a healthy child.
You’re not alone. Thousands of women with epilepsy have done this. With the right plan, so can you.
Can I stop my seizure medication if I’m pregnant?
No. Stopping antiseizure medication without medical supervision increases your risk of seizures, which can cause miscarriage, injury, or oxygen deprivation to your baby. Always talk to your neurologist before making any changes.
Which seizure medications are safest during pregnancy?
Lamotrigine (Lamictal) and levetiracetam (Keppra) are currently considered the safest options based on current research. They show the lowest risk of birth defects and developmental issues compared to older drugs like valproate or phenytoin.
Do birth control pills work with seizure meds?
Not always. Carbamazepine, phenytoin, phenobarbital, high-dose topiramate, and oxcarbazepine can make hormonal birth control less effective. Conversely, birth control can lower levels of lamotrigine, valproate, and others. Always discuss this with your doctor-don’t assume your pill is working.
How much folic acid should I take before pregnancy?
Women with epilepsy who are planning pregnancy should take 5mg of folic acid daily, starting at least three months before conception. This reduces the risk of neural tube defects by up to 80%. Regular prenatal folic acid (400mcg) is not enough.
Is it safe to breastfeed while taking seizure meds?
Yes. Most antiseizure medications pass into breast milk in very small amounts. Lamotrigine and levetiracetam are considered safe for breastfeeding. Even valproate is usually safe at low doses. The benefits of breastfeeding usually outweigh the risks. Talk to your doctor about your specific drug.
Why is valproate still prescribed to women of childbearing age?
Valproate is still used in some cases because it’s very effective for certain seizure types, especially when other drugs fail. But guidelines now require doctors to avoid it unless no other option works-and only if the patient is using reliable contraception. Unfortunately, access to specialist care isn’t equal, and some women still end up on it due to lack of alternatives or information.
If you’re unsure about your medication, your next step is simple: schedule a conversation with your neurologist. Bring your pill bottle. Ask: “Is this the safest option for me if I get pregnant?” If they don’t know, ask for a referral to an epilepsy specialist who works with pregnant patients. Your future child deserves that level of care.
